HomeMy WebLinkAboutR2020-0304 - Permit ApplicationDocuSign Envelope ID: 720242DE-EA3A-46C2-BD3B-E7EBE1A68EA1
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
_ 1000vic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# ���� �' p Cf www.newp 4_qW ca.gov 1 (949) 644-3200
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Application for Rep(i°igFgsidential Building Records
Application Fee: - $191.00 MAR 2 3 ZON Notice: -
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $129.00 or incomplete will be returned
#of Units: ❑ Address:
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City: Newport Beach State:
CA �
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Property Owner:
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CodeE77]
Owner Address:L-vil
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State: CA
Zip Code: 9ZIOla3
Home Phone:
Owner's Authorized Agent:—
Work PPPhoonnee�y:
Agent
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City:
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State: '—'
Zip Code:
Agent Email Address:
Escrow Company: SEssccro/w#/.���
Escrow Address:City: I Il IYt 1 1�L/1
State:'–bq�----' Zip Code: Escrow
Phone:
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Email Report to: r k o vDA it &.44, &P Ile f(Ymi 1
For Inspection call (Name): Direct Phone: 1 7
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections of the property listed above. I understand that if Building or Zoning
violations are discovered I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection:
9.0
Owner/Agent's signatureto decline Inspection:
Date:
Date: 3 19/20 0 J
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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